PVS SACKETT-WACONIA INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PVS SACKETT-WACONIA INC ERISA WRAP PLAN
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10088731001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10088731001 | | Number of Individuals Covered | 87 | | Total amount of commissions paid to insurance broker | USD $638 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 258633 |
| Policy instance | 1 |
| Insurance contract or identification number | 258633 | | Number of Individuals Covered | 122 | | Total amount of commissions paid to insurance broker | USD $43,050 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,434,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 ) |
| Policy contract number | 20949 |
| Policy instance | 2 |
| Insurance contract or identification number | 20949 | | Number of Individuals Covered | 120 | | Total amount of commissions paid to insurance broker | USD $8,245 | | Total amount of fees paid to insurance company | USD $25 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05399161 |
| Policy instance | 3 |
| Insurance contract or identification number | TS05399161 | | Number of Individuals Covered | 169 | | Total amount of commissions paid to insurance broker | USD $5,082 | | Total amount of fees paid to insurance company | USD $469 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $39,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10088731001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10088731001 | | Number of Individuals Covered | 49 | | Total amount of commissions paid to insurance broker | USD $276 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 258633 |
| Policy instance | 1 |
| Insurance contract or identification number | 258633 | | Number of Individuals Covered | 86 | | Total amount of commissions paid to insurance broker | USD $10,762 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $758,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 ) |
| Policy contract number | 20949 |
| Policy instance | 2 |
| Insurance contract or identification number | 20949 | | Number of Individuals Covered | 85 | | Total amount of commissions paid to insurance broker | USD $4,827 | | Total amount of fees paid to insurance company | USD $34 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,381 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000B3TH |
| Policy instance | 3 |
| Insurance contract or identification number | G000B3TH | | Number of Individuals Covered | 109 | | Total amount of commissions paid to insurance broker | USD $3,291 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $21,942 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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